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Mobile health in your palm

Looking to better manage your diet, your vital signs or a chronic disease?

There's a mobile app for that.

One of the current buzzwords in health care technology is "mHealth," for mobile health. At its simplest, the concept encompasses regular text messages to pregnant mothers charting the baby's growth.

But boosters envision more complex applications that would integrate medical devices, wireless networks and mobile phones to reach large segments of the population and help them manage their health and ailments.

That potential is fast arriving here in Maryland and beyond. Rockville-based CTIS Inc., for instance, is working with Walter Reed Army Medical Center to design an app called "mWarrior" for soldiers suffering from post-traumatic stress disorder to use on smart phones. And Baltimore-based WellDoc has devised an application that allows users to wirelessly connect blood glucose meters to their cell phones.

Software designers, medical device manufacturers, wireless providers, hospitals and insurance companies are targeting different aspects of the complex effort — including learning how to tap the potential of mobile devices in health care and getting the technology to "talk" to each other. They are asking: How would a blood-pressure monitor communicate with a smart phone?

Industry observers are excited about the potential and say the key is finding ways that consumers can easily use and widely adopt the mobile health technologies.

The mHealth industry is "extremely diverse and all over the map," said John Moore, health care technology analyst and managing partner with Chilmark Research in Cambridge, Mass. "There's a major issue with consumer education and getting them to understand what this is, and how will this be used."

As more powerful smart phones have been embraced by consumers, companies are rushing to develop apps that encourage users to focus on their health and well-being. And more manufacturers are designing medical devices that can integrate with wireless networks and mobile phones.

The diversity of the industry was evident at the mHealth Summit in Washington last month. Mobile health practitioners, technology companies and public health experts from all over the world participated in the conference — which had triple the attendance from the year before, at about 2,400.

The market is potentially vast. Research2Guidance, a German-based market research company, estimates that mobile health applications will be used by 500 million people of a total 1.4 billion smart phone owners worldwide in 2015.

In the United States, nearly three in 10 cell phone users have accessed medical information on it, according to a recent survey by the Pew Internet and American Life Project. And about one in 10 Americans have apps on their phones that help them track or manage their health, according to the survey.

"The Internet is changing people's relationship to information, and wireless access makes information portable, personalized and participatory," said Susannah Fox, a researcher with Pew.

PriceWaterhouseCoopers' Health Research Institute recently found in a survey that 40 percent of consumers were willing to pay for remote monitoring devices and a monthly service fee for the convenience of being able to send data automatically to their doctors. The firm estimated that that market potential ranged from $7.7 billion to $43 billion a year.

But big questions remain over who will ultimately bear the majority of the costs for such new technologies: patients, insurance providers, hospitals, the government, or some combination.

And there's another issue to watch. The Food and Drug Administration, which regulates medical devices, is developing new guidelines for mobile health applications and devices, to respond to the emerging marketplace. The FDA could clamp down on new mobile health devices and applications that pose a safety risk.

So far, mobile health applications available on the main smart phone platforms are numerous and broad, and still largely in their infancy in terms of technological sophistication and usefulness, according to industry observers.

Some programs and applications use simple text messages to help people quit smoking or better manage a pregnancy. Text4Baby, for instance, is a popular text-messaging program that sends texts weekly to mothers to help them through pregnancy and a child's first year.

More complex technologies integrate cell phones with Web-based software, electronic medical records and even medical devices to deliver better chronic care for a disease like Type II diabetes.

WellDoc Inc., a Baltimore-based company, makes chronic disease management software for mobile phones. The company has received FDA approval to sell its mobile software for use by people who suffer from diabetes and recently partnered with AT&T Inc., which has launched a health care technology business.

WellDoc's application allows users to connect a blood glucose meter wirelessly to their cell phones, for easy transfer of data. The company is making its software compatible with various cell phone makers on the market, such as Apple's iPhone and Google's Android phones.

"We think it's really cool," said Ryan Sysko, chief executive officer of WellDoc. "This is a homegrown Maryland innovation."

CTIS Inc. has built a suite of mobile health products for both patients and physicians to use, including the mWarrior app. The company is also developing a series of applications for Apple's App Store and Google Android's App Market that manages patient health records and physician records.

Raj Shah, chief executive of CTIS, said his company is working with larger companies such as Oracle, Microsoft and Google to build secure data repositories for patient and clinician data. The Obama administration has committed around $20 billion to subsidize improvements in electronic medical records, and Shah said that will soon create an abundance of health care data in electronic form that could be useful on mobile devices.

"Where we didn't have a lot of data, suddenly we'll have a lot of data," he said.

How to incorporate, manage and use all that health data is a chief concern of Alan Viars. The Baltimore entrepreneur who runs Videntity, a consulting firm, has been working on a free, "open source" programming language that would enable medical devices, such as glucometers and blood pressure monitors, to communicate with computers and mobile phones.

He figured a way to configure a Wii balance board, used with the popular Nintendo Wii gaming console, so that it transmits your weight wirelessly to Facebook. He also designed a way for a blood pressure monitor to send a text message of your readings.

All of this innovation has spurred concerns about a need for an open set of common standards for devices and applications to communicate with each other. Otherwise, different technology companies are poised to offer their own solutions to hospitals and patients that may not be flexible enough for changes in the future.

"Let's create a language that allows all the devices to talk," said Viars. "I'm thinking about the back-end and the standardization of data. That's the sexiest part of what I'm working on."



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